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Vascular access surgery: a 2-year study and comparison with the Permcath
D A Mosquera1, S P Gibson, M D Goldman
1Department of Surgery, East Birmingham Hospital, UK.
Insights
For hemodialysis patients, the Permcath (central venous catheter) shows comparable outcomes to secondary vascular access surgery. It may serve as a primary access option for those with limited life expectancy.
Area of Science:
- Nephrology
- Vascular Surgery
- Medical Devices
Background:
- Vascular access is crucial for hemodialysis.
- Traditional surgical options include arteriovenous fistulae and grafts.
- Central venous catheters (Permcath) offer an alternative access method.
Purpose of the Study:
- To compare the long-term efficacy and safety of primary/secondary vascular access surgery with central venous catheters (Permcath) for hemodialysis.
- To evaluate patency rates and complication profiles of different vascular access modalities.
Main Methods:
- A 2-year prospective study of primary and secondary vascular access surgery.
- A retrospective study of central venous access using flexible silicone catheters (Permcath).
- Comparison of cumulative patency and survival rates, alongside complication analysis.
Main Results:
- Primary fistulae: 64.8% patency at 1 year, 57.7% at 2 years.
- Secondary procedures: 48.1% patency at 1 and 2 years.
- Permcath: 74% survival at 1 year, 43% at 2 years; comparable to secondary access, with lower surgical complication rates but risks of infection and bleeding.
Conclusions:
- Permcath is a viable alternative to secondary vascular access for hemodialysis.
- Permcath may be considered for primary access in patients with limited life expectancy.
- Careful monitoring is needed to manage Permcath-related complications like infection and bleeding.
Abstract:
The results of a 2-year prospective study of primary and secondary vascular access surgery for haemodialysis have been compared with a retrospective study of central venous access via a flexible silicone catheter (Permcath). Cumulative patency for 61 primary fistulae in 57 patients was 64.8% at 1 year and 57.7% at 2 years. The patency of 55 secondary procedures in 43 patients was 48.1% at 1 and 2 years. Cumulative survival of 64 Permcaths inserted into 51 patients was 74% at 1 year and 43% at 2 years. Surgical complications included explorations for bleeding (2), haematomas (4), swollen arms (4), and inadequately dilated veins (4). Permcath complications included explorations for bleeding (3) and a temporary recurrent laryngeal nerve palsy (1). Exit site infection and septicaemia rates were 4.95 and 3.36 per 1000 catheter days respectively, but 20.6% of septicaemic episodes occurred in a patient who refused catheter removal. For haemodialysis, the Permcath is comparable with secondary vascular access. The Permcath may have a primary access role in patients with limited life expectancy.